TherapeuTics for The clinician Comparative Evaluation of Men’s Depilatory Composition Versus Razor in Black Men Chesahna Kindred, MD, MBA; Christian O. Oresajo, PhD; Margarita Yatskayer, MS; Rebat M. Halder, MD Shaving with razors often is problematic for men having with razors often is problematic for sen- with sensitive skin, especially black individuals sitive skin, especially skin of black individuals. who are generally prone to developing pseudo- S This method of shaving often leads to erythema folliculitis barbae (PFB). For patients with PFB, and irritation. Moreover, black men are prone to pseu- physicians often recommend shaving with depila- dofolliculitis barbae (PFB), a common and distressing tory creams that chemically remove hair from the disorder in which the growing hair shaft curves back skin surface by dissolving keratin. This 1-week, into the skin, producing a foreign body inflammatory controlled, single-center, split-faced,CUTIS randomized reaction.1 Physicians often recommend growing a trial compared shaving with 3 different depila- beard, which is not an option for some patients,2,3 or tory compositions to shaving with a manual razor using a depilatory cream. Depilatory creams chemi- in black men. One depilatory composition was cally remove hair from the skin surface. The active withdrawn during the study because of the high ingredients of depilatory creams dissolve the keratin incidence of adverse events. The depilatory of hair by lysing the disulfide bonds in the hair, which compositions produced fewer papules and more results in a softer hair tip and decreases extrafollicular irritationDo immediately after useNot and to a greater and transfollicularCopy penetration of the hair. extent than the manual razor; the irritation was A PubMed search of English-language articles transient and more often subjective than objec- indexed for MEDLINE using the Medical Subject tive. In this preliminary study, the result of using Heading (MeSH) search terms shaving or barbering depilatory compositions was that the skin looked with depilatory cream, depilatory creams, and and felt smoother compared to shaving with a depilatory yielded no published trials with human razor. Depilatory products are recommended for participants about depilatory cream and shaving patients who develop PFB or are unsatisfied with the beard area. The common problems associ- the results of shaving with a manual razor. ated with shaving with a razor coupled with the Cutis. 2011;88:98-103. lack of published data underscores the need for a randomized controlled clinical trial that com- pares depilatory creams to shaving with a razor. The purpose of this study was to compare shaving with 3 depilatory compositions to shaving with a Drs. Kindred and Halder are from Howard University College of manual razor. Medicine, Washington, DC. Dr. Oresajo and Ms. Yatskayer are from L’Oréal USA, Clark, New Jersey. Methods Funded by a grant from L’Oréal USA. Dr. Kindred reports no conflict Study Design—A total of 101 black men aged 18 to of interest. Dr. Oresajo and Ms. Yatskayer are employees of 66 years were recruited for this single-center study. L’Oréal USA. Dr. Halder received a research grant from L’Oréal USA. Correspondence: Rebat M. Halder, MD, Department of Three compositions were used in the study. The fol- Dermatology, 2041 Georgia Ave NW, Washington, DC 20060 lowing active ingredients comprised each composi- ([email protected]). tion: composition 1 (powder), calcium hydroxide 98 CUTIS® WWW.CUTIS.COM Copyright Cutis 2011. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. Therapeutics for the Clinician and barium sulfide; composition 2 (powder), calcium because of the frequency of adverse events. Of the hydroxide, guanidine carbonate, and calcium thio- 35 participants who used composition 2, 21 com- glycolate; composition 3 (cream), calcium hydroxide, pleted the study, 11 had an adverse effect, and lithium hydroxide, and thioglycolic acid. Composi- 3 were lost to follow-up or dropped out. Of the tions 1 and 2 were powders that the participants 28 participants who used composition 3, 24 completed mixed with water to form a paste; composition 3 the study, 2 had an adverse effect, and 2 were lost to was a cream. Participants were required to have a follow-up or dropped out. history of depilatory use and pass a sensitivity test. Assessments—For each composition, 3 compari- The sensitivity test entailed applying the paste or sons were made: razor compared to depilatory com- cream to a quarter-sized area of the beard area. After position, razor before compared to razor after, and waiting 7 to 9 minutes, the participants rinsed the depilatory composition before compared to depilatory product off without scraping. Clinicians assessed the composition after. As previously stated, composi- area for signs of irritation immediately after the test tion 1 was withdrawn from the study. and 24 hours later. Individuals without signs of irri- For composition 2, the following assessments were tation were allowed to enroll in the study. Women, made. Compared to the razor, the depilatory compo- children, and those unable to provide consent were sition generated more subjective irritation on visit 1 excluded from the study. (P5.025), visit 2 (P5.008), and visit 3 (P5.002), After passing a sensitivity test, the participants and more objective irritation on visit 3 (P5.001). shaved with their preferred routine at home on a To a greater extent than shaving with the razor, Saturday, and then made a total of 3 visits to the use of the depilatory composition improved tactile clinic on Monday, Wednesday, and Friday. At each roughness (P5.001), visual roughness (P5.004), and visit, the participants shaved one side with the ran- unevenness (P5.008) on visit 3. Compared to base- domly assigned depilatory composition and the other line, the depilatory composition worsened subjective side with the manual razor. All participants used irritation on visit 1 (P5.046), visit 2 (P5.014), triple-blade manual razors with new blades provided and visit 3 (P5.008), and objective irritation on for each shave as well as a shaving gel for the razor visit 3 (P5.002). On the depilatory side, shaving side. For the depilatory side,CUTIS all participants used a improved tactile roughness on visit 1 (P,.0001), spatula (wooden tongue blade) to remove hair and visit 2 (P,.0001), and visit 3 (P,.0001), and visual cream, and then rinsed with water to remove any roughness on visit 1 (P5.011) and visit 3 (P5.008) residual cream. Before the participants shaved, the compared to baseline. On the razor side, shaving physician photographed both sides of the face and with the razor improved tactile roughness on visit 1 used a 4-point scale to assess objective and subjective (P,.0001) and visit 2 (P5.001). signs of irritation, tactile roughness, visual roughness, For composition 3, the following assessments and Dounevenness of skin tone. NotAfter the participants were made.Copy Compared to the razor, the depilatory shaved, the physician repeated the photography composition generated more subjective irritation and assessment. The participants did not shave on on visit 1 (P5.025) and visit 2 (P5.025), and Sunday, Tuesday, or Thursday. After shaving at home more objective irritation on visit 3 (P5.001). To a on Saturday, the participants were not allowed to greater extent than shaving with the razor, use of the shave at home until after the completion of the study. depilatory composition improved tactile roughness Statistics—For all attributes, a Wilcoxon signed (P5.002), visual roughness (P5.004), and uneven- rank test was used for comparisons between ness (P5.011) on visit 1; tactile roughness (P5.033) 2 products at each time point. For each product, a and visual roughness (P,.0001) on visit 2; and tactile Wilcoxon signed rank test also was used for over- roughness (P,.0001), visual roughness (P,.0001), time comparisons (ie, visit 1 vs baseline and visit 2 vs and unevenness (P5.001) on visit 3. On the depila- baseline). The statistical significance level was set tory side of the face, objective and subjective irrita- at P≤.05. tion worsened after using the depilatory composition on visit 1 (P5.020 and P5.046, respectively), visit 2 Results (P5.020 and P5.025, respectively), and visit 3 Study Participants—Of the 101 participants recruited, (P5.001 and P5.009, respectively) compared to 73 enrolled in the study. A total of 45 participants baseline. On the depilatory side, shaving improved completed this preliminary study. Of the 10 partici- tactile roughness (P,.0001) and visual roughness pants who used composition 1, 2 completed the study, (P,.0001) on visit 1, tactile roughness (P,.0001) 5 had an adverse effect, and 3 were lost to follow-up or and visual roughness (P5.002) on visit 2, and tactile dropped out of the study. These 10 participants and the roughness (P,.0001) on visit 3. On the razor side, use of composition 1 were withdrawn from the study tactile roughness improved on visit 1 (P,.0001) and WWW.CUTIS.COM VOLUME 88, AUGUST 2011 99 Copyright Cutis 2011. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. Therapeutics for the Clinician A B CUTIS C D Figure 1. A study participant before shaving with composition 3 (A), after shaving with composition 3 (B), before shavingDo with razor (C), and after shavingNot with razor (D). Copy visit 2 (P,.0001) while visual roughness worsened erosions that led to their withdrawal from the study. (P5.034) on visit 3. Figure 1 is representative of the Both stated that because the depilatory composition results for participants who used composition 3. did not produce a sufficiently close shave on the first Adverse Effects—Of the 10 participants who used visit, they attempted to generate better results with composition 1, 2 completed the study, 5 developed a more aggressive technique with the spatula on the moderate irritant contact dermatitis (ICD), and 3 did second visit.